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OMM/OCFS/OTDA Materials: 1998 GIS Messages From OMM
GIS 98 MA/22: Medicare Maximization Policy for Nursing Facility Residents
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GIS 98 MA/022 New York State has been an active participant in the Multistate Skilled Nursing Facility (SNF) Case Mix Payment Demonstration since July 1, 1995. This demonstration, developed by the Health Care Financing Administration, established a Medicare prospective payment system for nursing facility services which more closely aligned reimbursement to the resources needed to care for the resident. The Medicare prospective payment system utilized RUGS III as a patient assessment model which classified nursing facility residents
within one of seven specific categories: Rehabilitation (special); Extensive Service; Special Care; Clinically Complex, Impaired Cognition; Behavior Problems; and Physical Functions (reduced). Under the demonstration, nursing
facility residents falling into any one of the first four categories received automatic Medicare coverage.
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Created: 11/19/2003
Updated: 11/20/2003
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